man. my VAcation has turned from a chill 8-3 to an annoyingly busy 8-5. I dunno why patients keep coming in. we need to hide the signs or something. I am totally spoiled by the schedule here. Every minute after 3 hurts! I keep looking at the clock thinking wtf i'm still here?!?!..
primary care i think, is not for me. now i know why House always hated clinic duty... because it totally blows, that's why. outpatient cases are so boring. i want me some real medicine. getting sick of seeing obscure back pains we can't cure. Getting xrays or bloodwork and then handing off to specialists. or maybe i'm just bitter because i'm doing 4/5th the same job as our interns while there's a 110k differential in salary/tuition.
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lately i've been trying to figure out if my former subi is hitting on me. we've been chatting it up a lot recently and she keeps insisting we NEED to go out for some drinks together. which doesn't compute because i'm a big dork and she's cute with a gargantuan rack. i keep thinking, it's a trap- grab an ax! i mean i can be a charming pig, but come on...
and oh yeah i guess i should mention she has a boyfriend. but they're practically married. well except for the long distance thing. but he is damn rich.
i guess it doesn't compute because i don't usually get that vibe when we're hanging out (not through these insecure and blind eyes anyway). and i know i don't give that vibe out because a) i'm a coward and b) i never really looked at her that way, well except when the eyeballs would wander cuz of the aforementioned goods.
so i'm honestly 95% sure she's not interested. which is good except for the 5% chance of a desperately needed ego boost. but i wouldn't want to fuck someone else over like that anyway. and i think we make pretty awesome just friends.
it is hard to find a good medschool friend who is totally on the same wavelength as you- similar smarts, cynicism, laziness and procrastination ability. she's my new 'smart' friend now that my man-crush step1 betting partner took a year off. it's great. we can totally blow off 3 hours talking shit about stupid/mean/ugly/douche classmates/interns/residents/attendings/patients. but it's obvious we both still really care about patients and gay shit like that.
it would never work out anyway, for a number of different reasons. besides i'm totally in love with my previous subi. i just need her to get back from her away rotation so that i can make my move. and by move i mean i plan to club her on the head and drag her into my cave.
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fuck i keep coughing. i think i have TB. i will go through my records and execute all of my former patients if i ahve TB.
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i really need to study. i really really need to study. i feel like everyone is getting smarter than me and it's pissing me off. this upcoming shelf exam is starting to scare me and this damned step up to medicine book is bigger than my step1 first aid review book.
what i need to do is stop looking up reading up on dumb shit like wrestling and mma fighting news.
but check out fedor snap like a cobra and maul the shit out of tim sylvia. what an f'n assassin. hands down the scariest and most badassed mfker on the planet. (ffd to 5:30 if you want just the action):
definitely no urology for me. I've touched more than enough foreign penises within the last couple of weeks to last for this lifetime. that would be 2. which is about 800 too many. So gross.
I think i would do a better genital exam if i strapped a gas mask to my face. it's hard to focus when you're in the presence of nasty-smelling genital funk and you're so acutely aware of alien penis molecules eating through your gloves and entering your trachea on their way into the depths of your soul.
a close second to nasty male genitals has got to be diabetic feet. or dried out edematous statis-dermatitis'd ungroomed old-person foot. especially when you yank off the sock and it's like someone setting off a little dirty-bomb with little bits of dried up foot falling to the ground and untold getting aerosolized.
so gross.
you're sitting there and you realize your hand is on your face and even though you gloved and washed and what not you start thinking about where it's been you start imagining you can still smell it on your hands and now it's all up in the pores of your face.
maybe i'll be desensitized eventually and get used to this sort of thing. i dunno though... i'm still scared of spiders after 27 years.
maybe it's a sign i should really go into radiology. or perhaps the sterile OR field will be different.
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i'm getting pretty sick of outpatient at the VA. you know you're spoiled when being let out at 5 is a long ass day. i'm sick of looking knee pains and foot pains and ambiguous back pains. i'm tired of doing physicals. i want some damn daily blood values and some followup on patients with more acute illness.
i'm kind of sad that internal medicine is coming to an end in another 6 weeks. i feel like i need another oh... 25 weeks or so. i feel like i still don't know shit. i certainly haven't seen much on the floor. and it's disturbing that i may not have a chance to come back to this stuff which seems like the most important foundation of medicine.
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I think i need to work on my patient rapport. i'm pretty sure my patients like me but i think my act is getting boring. i'm too busy focusing on being a good listener and empathetic and what not... i think i need to try to inject some humor into my routine. not to the extent of being insensitive of course but i just feel like my attitude is too serious esp during physical exam and they could probably use a lighter atmosphere.
things just seem much happier when the attending or chief is in there doing their thing... they're so much more comfortable in what they can say or do. the patients know they're talking to a bonafide MD, they're more relaxed and smiling, and the interviews are much shorter because i've done all of the dirty work. i feel like i'm playing good cop / boring cop.
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what i really want to do is work in the "hmmmm... i've never seen that before" comment to get em really worked up. which is true for almost everything i look at.
i feel kind of like how i do when i'm doing a physical exam on patients. don't really know what i'm looking for and i'm more or less just going through the motions. blah blah blah. waking up, tying my tie, going in, seeing my patients, going home, think about reading, read up on sports/olympics instead, consciously avoid any real news stories that don't involve celebrity gossip, maybe catch up on some inane tv show, go to bed 2 hours too late, rinse and repeat. i do a good job i suppose but i'm waiting to feel inspired by something... or anything.
outpatient is super chill though. in fact if i only had an actual positive income and didn't have to feel guilty about not reading... by-golly it might actually be a pretty sweet job.
the VA is really lonely though. at least at the main hospital i would run into people on other rotations whom i could shit-talk with or about. i miss my last two subi's. we were so on the same wavelength, so laidback and chill about everything, while still caring and smart. didn't hurt that they were also pretty nice to look at. but it's nice having that 4th-year student buffer who you're not as worried about bothering for time. my interns were pretty chill but they were so damn busy i felt bad everytime i asked a question. plus i have serious MD-envy so it creates tension from my end.
it's always weird when you start on with a whole new crew and you're not sure about the individual levels of anal-retentiveness and you're wondering how far you can go with your jokes and such.
on the plus side one of my new attendings is taking computer science courses cuz she's a total cool uber-nerd and we're hitting it off well, i think. we were shooting the shit about CS stuff and it was cool until she started talking about least squares and algorithms and unix crap that was all over my head. former math major and obviously way smarter than me so i had to do my head-nod thing to pretend like i knew what she was talking about. dammit even in my own field i'm an idiot. way to rep cs.stanford.edu
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the VA is pretty hilarious though. now i don't claim to be an expert... or even know jack shit... about universal health care and what not, but if government run health-care means anything like the VA... well god help us. The VA is like... going into DMV (not cali dmv which is actually pretty smooth sailing the last time i was in there).
the place is like a ghost town before 8 and after 3. i mean the official hours are like 8-5 but once it hits 3:30 people are packing their shit up. can't miss the shuttle. just try to get any labs or imaging done on a friday afternoon. i mean why stay late and put the extra time in when you are salaried.
the f-ing cafeteria blows too. we need more drug reps dammit. if i were running the show every week i would threaten to change PPI's on the damn pharm companies to make sure we have food every day.
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i don't understand belligerent patients. don't they realize that when you're mean nobody likes you and when nobody likes you people don't go the extra mile to make sure you're happy and healthy. that no one's gonna lose any sleep making sure you got the correct correct diagnosis that might be way down on the differential list because you're out the door in a day anyway because you're not acutely sick anymore. or stay that extra hour to make sure all of your questions are answered. it boggles my mind why you wouldn't be nice to the people who have your life in their hands.
baffling because some patients are just so sweet. they might have metastatic cancer all up in their fuckin eyelids or wahtever but they're still smiling or making jokes or even if they're crying you can tell they're fighting and appreciate your help. and you leave the room wanting to donate your kidney to their cause.
so why would you want to be THAT guy? that guy who when I come in at 6am i find myself secretly hoping you coded to the ICU or left AMA so i don't have to waste extra braincells on your daily paperwork. i know your life sucks and whatever and you probably go home to a broken family but don't take your shit out on me. the attending, maybe. but me? heck my life is probably worse than yours. certainly more pathetic.
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because i'm a retard i watched all of top chef season 4 this weekend. i <3 that show. i love how those judge chefs were so badass they were like, "this was so good, i think i would not even mind having seconds". i can't wait til i'm eating at 4-star restaurants and not finishing my plate so i can say shit like that.
man i need to upgrade my eats.
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RIP bernie mac and shaft. i never watched your tv show because it seemed pretty lame but your kings of comedy routine was a goddamn classic.
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eww the new facebook is kind of gay. not that there's anything wrong with that. but i think i'll wait until they force me to change like my.yahoo did after 3 years. now the new my.yahoo is really really gay. not that there's anything wrong with that.
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before i get to my song of the week i just want to say how much more i love my iphone since the sdk/appstore came out. well except for all of the cool little games which keep me from doing any studying at borders.
the coolest app has to be "Shazam" which will record 10 seconds of whatever song is playing in the car, send it to a server, analyze it and then tell you what the artist/title/album is with cover art etc. i don't know how many times i've used this thing in the car. the other day we were at a restaurant and a new song started playing which nobody knew and i was like a hero after i whipped out my phone.
epocrates ain't bad either. i seriously don't know how i lived pre-iphone. it's like i can never not-know anything anymore when i have instant access to wikipedia on my phone.
anyway i found two cool songs on the radio today which inspired this techno-boner rant. so we have 2 songs of the week since this blogging thing is so sporadic..
and here they are for you my 3.5 readers to enjoy:
1) the "cool" song - O.A.R. - Shattered (live) If you like the song and don't mind a little criminal activity you can find the whole album here
2) the "fruity/sweet" song - Plumb - In My Arms (i think this is actually a christian band):
medicine is so tiring. i rounded for 5 hours today post call. so many new patients. I kept having this raging internal debate in my head as we went over patient after patient- am i more sleepy, or more hungry?
especially tiring when you're running around like a headless chicken and you feel like you're getting in the way more than you contribute. it's exhausting being so stupid and incompetent.
i guess i just have to take it on faith that eventually... i'll get there. but i feel so stupid compared to our subi's. who seem so stupid compared to our interns. who seem so stupid compared to our residents. who seem like total dumbshits compared to our attendings. maybe i've just had two extra fabulous attendings.
all of that knowledge to accumulate... sometimes you just think, fuck it, what's the point. it's like after two years of busting your ass and all of your rapidly disintegrating knowledge base isn't worth jack shit.
i'm lost in a sea of trade names i have to pick up, dosing levels, abbreviations... all that crap. then having to remember patient names and doctor names and nurses names.
i find it all very exhausting. there's not enough victories in medicine. so many dumbasses putting themselves into the hospital for the nth time because they can't stop drinking. so many f'ing drug addicts. it's like every patient we need to start a goddamn withdrawal protocol.
and then you finally have the people who don't want to be sick. it makes you sad when despite all of the smiles and time spent and the caring and wanting to help you realize there's nothing you can do. that you spent a week and a half working towards a diagnosis and being there 3 hours late answering questions... and when you finally get a diagnosis you realize your patient can't get the fucking curative surgery anyway because they don't have any health insurance. you feel like you're doing a good job and then shit like that just ruins your day.
i wish there were more victories. More curing instead of discharging people a little less sick than they came in.
I watch my attending everday and how awesome and patient she is with everyone and I'm just amazed. how much she cares and how she might be the nicest person i've ever freakin met. i wish i could be that caring. because honestly sometimes i just want to slap some of our patients.
she's probably just faking it. she probably goes home and clubs her dogs or something.
I find myself leaning more and more towards doing radiology. And it feels so dirty and cheap.
i think my problem is i'm a lazy overachiever. i'm always willing to put the work it... but i hate myself as i do it. I care too much about my patients... or maybe my grade, who knows... but then i go home and whine about how tired it made me. i wish i could either just embrace the laziness or be an earnest hard worker.
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i need to stop whining. randy pausch died. :( i need to be more positivbe.
As a med student on rotations with theoretically zero authority, nothing feels better than spotting an error in logic or medications, or coming up with a different diagnosis that results in a tangible change in medical management.
nothing is more vindicating than showing the powers that be above you that you were there to catch screwups which they with the md behind their signatures are ultimately responsible for. me, a lowly msiii.
sure, maybe it was my poor h&p that led us in the wrong direction. yeah, in fact that's exactly what it was... but who's counting?
i mean, if i hadn't caught my own fuckup, where would they be? shit up the creek without a diagnosis, that's where.
the key is making the error under your unsuspecting first attending. then catching the error after hours and then calling up your brand new second attending who's taking over the case and now thinks, 'damn, this kid is dilligent'
score!
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I sent in another one of my H&P writeups to my preceptorship last friday and i got back an email today from him which said only the following: "Suboptimal, Gerlad. See comments"
ouch! that kinda really hurt my feelings...
it's okay though because i purposely set my writeup standards low so i can trend upwards. i even turned it in 2 days later than the other two in my group. still it was a little harsh.
i don't understand why they expect us to write 50 freaking pages up in grand detail when in reality all of the real docs write 2 sentences in ineligible chickenscratch. get real.
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On the other hand i met with my (first) attending today for an evaluation-vs-self-evaluation session. Self evaluation is a very tricky business. You always want to underestimate yourself. But then again you don't want to be so thoroughly convincing in the explanation area that they agree with your score assessments. I gave myself all satisfactorys except for motivation, which i put as excellent. I think it worked as he upgraded my grade for every category and kept the excellent for motivation. score! i almost shed a tear in my pants when he told me my knowledge base was definitely above average.
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I'm having this inner battle to decide how much I care/should care. On the one hand, I spend a lot of extra time in the hospital in talking to and caring for my patients. I'm usually there on average over an hour or two later than my counterpart. Not sure why that is but it always ends up that way somehow.
On the other hand, I'm consciously aware of the fact that I spend way too much fucking time in the hospital. Going back to make sure their pain meds got ordered like you asked (they were). Annoying the tired ent doc to make sure your less than sane patient's ridiculous request gets made like you ridiculously promised. Spending extra time with my patients to answer their questions and make small talk and letting them know someone kinda cares while I glance at the clock and realize I don't have any time for reading again tonight. Which begs the question- do you really care if you resent/hate the fact that you care?
Sure it makes the patient feel better (maybe) or the attendings residents realize your dedication (doubtful they notice). But then again most of the time I come home look at the clock, think about how tired i am and conclude it probably wasn't worth the extra effort.
Third year is freaking tiring. Or medicine in general. This whole business is like a mirage. People always just keep telling you to temporarily self-sacrifice and that there's light at the end of the tunnel. but then you look around at all of the doctors and they're all still self-sacrificing and miserable and how many are all that happy.
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Yesterday me and the subi tracked down the source of the popsicles we saw our chf patient snacking on. it looked so good i almost sntached it from him. I had been obsessing about the damn thing for the last week. now I'm determined to smuggle a popsicle every day until i make back my 65k. nice too because it's freaking hot up in hurr.
I've come to the realization that I kind of suck at this. I am bumbling around like a headless chicken and I feel like I am mostly just getting in the way.
I think my main problem is my very-short-term memory. I've always been more of a conceptual person and when it comes to remembering names, numbers etc I tend to forget crap like that within seconds of being told.
I will go to a computer, read up on a couple of lab values, write them down, have it straight in my mind what I want to say and what the relevance of each value is, but as soon as I have to report to anyone my findings I lose track of what I wanted to say, I forget key points and I talk all jumbled and garbled. I'll have one or two simple questions I want to ask a patient but after getting through the small talk I'll forget what they were.
I think I'm just not very good at following directions or ordered tasks. If I give myself or someone else gives me a couple of tasks to do I have to keep reminding myself what the next task and I'm terribly inefficient.
I'm not very good at doing evaluating physical signs (still mostly going through the motions), I can't keep up with all of the clinical jargon and drug regiments and crap flying left and right...
I think my only real strength is my understanding of organ system pathophysiology. The only problem is, when someone asks me a question directly I turn into a complete freaking moron- my mind blanks out. I was asked how to identify a-fib at the bedside (DUH- irregular irregular rhythm) and for some reason I started reasoning out heart block instead. god I felt like such a tool.
When he asks someone else or asks the group a question, I can almost always come up with good answers first but Im too timid to blurt out answers until there's a silence. I'm always coming up with very intelligent questions but I very rarely ask them on rounds because there's so many patients to get through and I don't want to annoy our interns.
So basically I think to any objective observer I'm performing about average or below. I'm most definitely not standing out.
Dammit, this has to change. I need to figure out a way to get myself, my thoughts and my huge overfreaking crowded pockets organized. I need to stop staying up so late for no good reasons and showing up tired without enough time to keep myself from panicking collecting data during prerounds. I need to start reading like a fiend. I probably need to stop blogging...
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So far I don't like 3rd year all that much. Too tiring and I feel like I don't learn much in a day. People are too busy to teach you stuff and it's mostly learning through osmosis, which is pretty inefficient. Talking to patients is fun and all but you don't learn much medicine from them. I get home and I'm tired and I soo don't feel like opening up a book so I end up watching more episodes of how i met your mother or something.
And everyone is so busy. You can only hang out with people for like 30 minute intervals. Don't even bother asking any surgery friends to hang out, their bedtime is like 8:30 pm.
Ok maybe if I stop whining I can actually get some reading in today. Hopefully I can turn a corner this week. It's probably better this way... don't want to set the bar high, you start off slow so they can see more improvement.
